Klinische Monatsblätter für Augenheilkunde
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Klin Monbl Augenheilkd · Aug 2013
[Characteristics of traumatic versus spontaneous wound dehiscence after penetrating keratoplasty].
After penetrating keratoplasty (PK) patients remain at risk for wound dehiscence at the graft-host junction even years after surgery. The aim of our study was, firstly, to assess the site-specific characteristics between traumatic and spontaneous wound dehiscence at the graft-host junction and, secondly, to determine the incidence of traumatic and spontaneous wound dehiscence. ⋯ The difference between both groups was significant regarding the localisation, the extent and the clarity of the re-sutured grafts. The nasal inferior part was the most affected area in traumatic cases probably as a result of indirect, contrecoup injuries, and the temporal part in spontaneous wound dehiscence probably due to direct minor forces.
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Poppers are a common drug belonging to the alkyl nitrite group and in use for several decades. They can be legally purchased for air freshening, but are illegal to buy for inhalation. Abuse is associated with maculopathy and visual loss as a rare side effect. ⋯ Although poppers have been in use for several decades, in 2007 in England, the popper composition was changed by law from isobutyl nitrite to isopropyl nitrite. It is hard to distinguish whether a specific nitrite group triggers the maculopathy or whether it is the dose level, thus suggesting the existence of a cumulative dose-response relationship. We postulate that a major factor of the manifestation of maculopathy is the individual limit of vulnerability. Despite decades of use, the majority of our series does not present any pathology. Limits of our patient population represents the HIV disease: three maculopathies of our series are HIV-associated and controlled by antiretroviral therapy, so that a clear distinction to the disease is absent. Poppers were earlier regarded to cause an AIDS-defining disease of viral aetiology: Kaposi sarcoma. We are well aware of that association and postulate that the observed maculopathies are not causally related to HIV disease and antiretroviral therapy. Considering the cultural background of our patients (multiple partners, frequent sex) and the disinhibiting effect of poppers, an increased risk of HIV disease is found. Since this disease is a rare disorder, patients should be asked specifically about poppers abuse. Further study of the effect of poppers on maculopathy is needed.
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Klin Monbl Augenheilkd · Feb 2013
[Pattern of injuries to the surgical team during ophthalmosurgical interventions].
Accidental sharp injuries among the health-care workers are frequent, especially in the surgical disciplines. Because there are only limited data available about accidental sharp injuries in small surgical disciplines, we investigated the occurrence of sharp injuries among ophthalmosurgeons in Switzerland. ⋯ We conclude that in ophthalmosurgery sharp injuries to surgeons or their surgical team happen frequently and only about 50 % of the cases are reported. This study shows that there is room for improvement concerning the documentation and the actions taken after an injury. Thereby potential sources of danger could be better monitored.
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Klin Monbl Augenheilkd · Sep 2012
Randomized Controlled Trial[Significant improvement in compliance with the face-down position after vitrectomy and gas tamponade].
The positioning of a patient in a "prone position" ("face down position", fdp) after pars plana vitrectomy with gas tamponade has been discussed controversially since the beginning of macular surgery. The "prone positioning" is almost standard although the duration varies. In most of the study designs for macular surgery "face-down positioning" is advised. However it is not clearly described how the "prone position" was achieved. In most of the studies it is not shown if the patients had suitable aids and how long and how efficiently they used them. Experience while practising this shows that the patient's compliance is a great challenge. Patients are mostly unable to comply, which could result in refusal. ⋯ By placing supports at the disposal of the patients, it is possible to improve significantly the compliance after surgery. To succeed in using the prone position also at home it is necessary to supply the patient with a support which is comfortable, cheap and easy to handle.
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Klin Monbl Augenheilkd · Aug 2012
Comparative Study[Subconjunctival or general anaesthesia in trabeculectomy--a retrospective analysis of the bleeding risk from a glaucoma surgeon's point of view].
The aim of this study was to compare the intraoperative and early postoperative outcome of trabeculectomy with mitomycin C in glaucoma patients undergoing general anaesthesia compared to those undergoing subconjunctival anaesthesia. ⋯ The perioperative risk profile of penetrating glaucoma surgery with subconjunctival anaesthesia seems to be similar to that of procedures under general anaesthesia. For prevention of postoperative filtering bleb bleedings, the administration of topical antiglaucomatous drugs should be stopped before surgery.